The Forgotten Part of Yesterday's ACA Decision

This could be very bad.

In a surprise move in its decision to uphold the ‘Obamacare’ mandate, the Supreme Court declared that states may opt out of the law’s Medicaid expansion without losing all federal funds for the program.

“In the 47 year history of the program, there has never been a successful challenge to any of the Medicaid expansions, so this was rather unusual,” said Ron Pollack, director of the consumer group Families USA.

The decision is expected to at least slow down implementation of the new Medicaid provisions. If states refuse to participate en masse, it could lead to significantly fewer people than the projected 17 million being covered under the Medicaid expansion.

Of course the states with the most poverty, like Mississippi, will be the first in line to opt out. Because they also happen to be brutally conservative. Good luck, Red Staters.

(h/t Jason Kalafat Attorney at Law)

  • Ellen Kuhlmann

    We can’t save people from their own willful ignorance. If states opt out, the most we can do is make sure the information gets out about what’s happening elsewhere, and the people can move, vote the bums out, or convince them to switch their views on this.

    FYI not all the states that sued against the act are against it. Here in WA State our attorney general joined the suit without consent of the legistature or the governor. Not sure why that was legal, but Rob McKenna is now running for governor, and backpedalling mightily on his opposition to the act. And he announced he’s not going to go to the GOP convention. Hope, though, that voters aren’t fooled and he loses. Bas***d.

  • JMAshby

    It’s their own goddamn problem.

    If Red state governors refuse to expand medicaid, and the people vote to re-elect them, it’s their own fucking fault.

    But I also think this is all rhetoric. When push comes to shove they will take the money and sign the checks themselves with a big shit-eating grin on their face.

    • Lazarus Durden

      Oh hell yeah they will. One thing the GOP is great at is hypocrisy. They have it down to a science, well they don’t call it a science since they don’t believe in it.

  • nicole

    It’s also possible that not as many will opt out as we think. Opting in carries not only significant advantages, but large amounts of federal monies. Greed may overcome their disdain.

  • jmby

    I was lucky to be able to work with the VA chapter of the Main St Alliance, a group of health policy experts and several Congressmen and Senators during the passing of the ACA. Our group had two people who were, hands down, the most knowledgable in the country about the Act, what it contained and what the ramifications would be. They, and most health policy folks, believe that the states will buy into the Medicare expansion for many reasons – one of the biggest being that the Fed. Gv’t. actually picks up almost all of the expanded Medicare tab. It takes a big payment burden from the states. Even the rabid red state governors are anxious to reduce deficits and this deal is too good for them to pass up.

    • agrazingmoose

      That seems to be the consensus opinion for today.

    • bphoon

      I’ll validate that. Our erstwhile governor, Sam Brownshirt…er…Brownback has quietly had the KDHS laying the groundwork for Medicaid expansion and creation of the health insurance exchanges. Dangle hundreds of millions of gummint $$$ in front of ‘em and they’re likely to snatch it up without compunction.

      Remember the number of GOP governors who used ARRA $$$ to close budget gaps even while lambasting the “tax & spend Democrats” for passing such a “boondoggle”?

  • roxsteady

    I saw this Republican woman last night on Lawrence O’Donnell’s show who’s job it was to set up these exchanges and she reminded the panel that when the CHIP program was passed, all 50 states opted in. She said that it’s been her experience that when you offer somthing like this many states will opt for the services. Now I too believe that many of the red states will opt out but, the citizens of those states may vote some of those bastards out or, while many not in large numbers at first, some might opt to move to neighboring states that do accept the program.

    • Lazarus Durden

      Oh no. They’ll keep the same ones in. They’ll rant and rave against these programs, and then come across state lines to take advantage of the same thing they railed against. It happened a few years ago when TN Care was better then the state healthcare in NC. People up in the mountains drove into TN just to deliver their baby so they could get TN Care. It’s one of the reasons TN had to scale it back.

      But of course we didn’t need national healthcare reform. Heavens no!

  • BadSaratoga

    It is comical to watch these southerners continue to be brainwashed by the Fox News propaganda machine. It’s like they have no critical thinking skills or common sense. Guess that’s what they blindly accept. I too say fuck em. The day they wake up and realize what they have been voting against, I will have no sympathy for them and it will probably be too late for them.

    Funny. Every time I get a call from a job recruiter touting an “exciting career opportunity” in a “rapidly-growing Southern state”, I’m quick to say no thanks. You couldn’t pay me enough to live anywhere down there.

    Lazarus Durden, I hope you can get out soon.

    As the Southern states continue to show us all their ass, I’ll happily maintain my New York residence.

    • astrocat96

      I tend to agree, but there are those of us in the South which are being hurt by policies we disagree with. The majority of peoplethe here probably are voting against their own interests, but real people get the shaft.

      • BadSaratoga

        I do agree. I have relatives in Texas who feel the same as you.

        In the end, we all pay.

    • Lazarus Durden

      One more year and I’m a ghost. North or West bound. Anywhere but the South.

      • desertflower1

        Head’s up! Don’t come here to AZ:) Not until it turns blue , that is:)

        • Lazarus Durden

          I’d love to live in New Mexico for a couple of years. My mother lived in ABQ and I loved it out there especially the food.

          • desertflower1

            New Mexico is beautiful. They don’t call it the “Land of Enchantment” for nothing:) Nice the way, there are some really beautiful places in AZ as well…you just don’t want to live here. Trust me.

  • Lazarus Durden

    This probably isn’t very compassionate for me to say this but… Fuck ‘em. Red Staters deserve every bit of this they get. I live in Northeast TN the place just down the road from Bristol where people line up at 4 AM to visit RAM, Remote Area Medical when they come to town. I guarantee you the majority of the people receiving RAM vote down the line GOP. I hear all sorts of vile shit from these people. This is ground zero for the Obama is a secret Muslim, socialist, etc. etc. rhetoric. I have only pity and confusion for them. Arguments based on evidence don’t work, reason doesn’t work, maybe the only thing that will work will be that things have to get so horrible they’ll finally wake up to see who is really hurting them.

    The truly sad part is most of them aren’t bad people, but when it comes to politics they just spew the horseshit Fox News puts out to them daily. And they lap it up. Fox News playing on TV, Michael Savage and Rush Limbaugh playing on the radio. It’s all the time.

    So yeah after living in this red state insanity land for the past 20 years and seeing absolutely nothing move economically, or socially I can’t garner much in the way of sympathy. They do this to themselves. It’s a ghetto and I’m trying to get out.

    • nicole

      The problem with this is that of course, many who reside in those states are innocent……….i.e., never vote Republican.

      But I feel ya. Having lived in the South for some time myself, I would be inclined to say the same thing were it not for all the innocents who would suffer the consequences.

      • bphoon

        …i.e., never vote Republican.

        Or never vote at all.

        I have sympathy with both posts above but those who insist on voting Republican against their own interests because they willfully fall for the shit Faux News et al feed them have nothing to complain about. Those who are otherwise eligible but who choose not to vote also have nothing to complain about–I strongly believe those who abdicate their duty as citizens also give up their right to bitch about the government.

        The only true innocents who are hurt in all this are the children. Lone Democrats (full disclosure: I’m a registered Democrat who votes without fail and who lives in Kansas) in a sea of red are, lamentably, collateral damage…

        • nicole

          You may be right, but I don’t want to see children and faithful Democrats suffer due to the ignorance of the rest.

          Adding….. I, too, am a registered Democrat who votes without fail.

          • Lazarus Durden

            We already suffer. There is nothing to be done. I know going into it that any vote I cast in TN in my district is a protest vote.

            My one example is a former colleague who is now an educator at the college level. He scraps by on working at three colleges because he’ll never get tenure without a doctorate but they’ll let him teach the survey courses. But he can’t get a doctorate because of his living situation. He has 9 children, seven of which were paid by TN thanks to TN care. He’s received WIC, and EBT (Food Stamps) for seven of them. He’s a veteran so he gets free health care at the VA, and everything else has been given to him by his church including two vans for his family. The man’s family lives on the charity of others basically.

            He’s also a rabid tea partier, and votes for the GOP down the line. The same party that has successfully turned the profession he loves so much, teaching, into something that is scorned and mocked.

            Meanwhile I don’t have children, and when I’ve been unemployed I didn’t take any unemployment assistance out of misplaced shame and pride thanks to being raised Republican and Southern Baptist. I scrapped by on charity from family, some of which I paid back, or worked odd jobs to make ends which is a lot harder then it sounds (one of the reasons I have immense respect for the undocumented workers I see outside of Home Depot that do it day after day. That is a hard life. ) I’ve worked full time and gone to school watching tuition climber higher and higher.

            I understand where you’re coming from Nicole and bless you for it, but I’m done. I’m leaving as soon as I can. There’s no opportunity here, and nothing to be done except to get out.

          • nicole

            I hope you’re able to leave soon. :)

            The thing is, children can’t just leave, and neither can some adults, so that’s what bothers me. Other than that, I would feel the same way, Lazarus.

          • Lazarus Durden

            Thanks Nicole. And honestly that’s the only reason I call myself a liberal down here. Without social programs a lot of children would be hurting, and they didn’t do anything wrong.

            Also a lot of this is just venting. I’m sick of holding my tongue, and sick of being civil to my friends who spout this stupidity. Most of the time we don’t talk about politics because they end up getting angry after I pick apart their arguments. It’s not that I’m any smarter just they only spout Fox News talking points and anyone with half a brain and some fact based knowledge can debunk them.

            But you’re right. Tomorrow I’ll think a little differently, but today I just wish all these wingers would stop with the hysterics.